1. Abstract
The COVID-19-Related Worries Measure (Semeraro et al., 2023) is a psychometric self-report assessment instrument formulated to evaluate the frequency, scope, and intensity of specific pandemic-induced cognitive apprehensions experienced by individuals over a preceding two-week window. Developed during the protracted phases of the global coronavirus crisis, the scale was embedded within an empirical investigation examining the structural interplay between maladaptive personality domains—specifically psychoticism, detachment, and negative affectivity as defined by the alternative model of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—and perceived psychological stress. A primary theoretical contribution of the instrument lies in demonstrating the operative mediating mechanisms of pandemic-specific cognitive intrusions and emotion dysregulation.
The scale consists of 9 ad hoc items evaluated on a 5-point Likert-type response continuum ranging from 1 (not at all) to 5 (very much). The instrument moves beyond conventional, unidimensional health anxiety metrics by sampling an array of ecologically valid stress dimensions provoked by the socio-sanitary emergency. These dimensions encompass worries regarding mandatory institutional quarantine and infectious vulnerability, structural supply shortages (e.g., pharmaceuticals, personal protective equipment, sustenance), acute macroeconomic and personal financial precarity, post-lockdown re-entry anxiety (agoraphobic trepidation regarding community re-integration), disruptions to idiosyncratic passions and work-life balance, and chronic derailment of long-term developmental milestones.
Psychometrically, the initial validation of the measure within an adult Italian cohort demonstrated satisfactory internal consistency, yielding a Cronbach’s alpha coefficient of .81. Structural equation modeling established that COVID-19-related worries act as a vital cognitive mediator through which underlying personality vulnerabilities translate into elevated psychological strain. By capturing both acute sanitary fears and broader systemic disruptions, the COVID-19-Related Worries Measure provides clinical researchers, epidemiologists, and health psychologists with an empirically validated, brief assessment of pandemic-related threat appraisals.
2. Keywords
COVID-19-Related Worries Measure, health anxiety, psychological stress, maladaptive personality traits, emotion dysregulation, cognitive appraisal, pandemic-related distress, re-entry anxiety, self-report inventory, psychometrics.
3. Authors
The COVID-19-Related Worries Measure was developed and validated by an interdisciplinary team of developmental, educational, and clinical psychological researchers based in Italy:
- Cristina Semeraro (Corresponding Author) — Department of Education, Psychology, Communication, University of Bari Aldo Moro, Palazzo Chiaia-Napolitano, Via Scipione Crisanzio, 42, 70122 Bari, Italy. Email: [email protected].
- David Giofrè — Department of Educational Sciences, University of Genoa, Genoa, Italy.
- Gabrielle Coppola — Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.
- Veronica Verri — Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.
- Morena Bottalico — Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.
- Rosalinda Cassibba — Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.
- Alessandro Taurino — Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.
4. Purpose
The primary purpose of the COVID-19-Related Worries Measure is to quantitatively capture and stratify the multi-faceted cognitive concerns elicited by the SARS-CoV-2 pandemic over an acute two-week temporal window. While standard psychiatric instruments historically evaluated generalized anxiety or hypochondriasis (such as the Health Anxiety Inventory or the Generalized Anxiety Disorder 7-item scale), these classic inventories were not calibrated to measure the pervasive disruptions wrought by large-scale biological disasters, mandatory home confinement, supply chain collapse, and existential threats to economic survival.
From a clinical and applied perspective, the measure was engineered to accomplish several objectives:
- Delineation of Pandemic-Specific Stressors: The instrument captures cognitive threat appraisals across both health and non-health domains, addressing the reality that public health crises trigger compounded socio-economic, interpersonal, and lifestyle ruptures.
- Identification of High-Risk Vulnerability Profiles: Within clinical screening frameworks, the scale aids in differentiating individuals displaying benign, reality-based concern from those experiencing debilitating cognitive perseveration, which can precipitate secondary psychiatric conditions such as major depressive episodes or panic disorder.
- Elucidation of Psychopathological Pathways: The measure acts as a specialized research tool designed to elucidate the mechanisms linking distal structural traits (e.g., DSM-5 Section III personality traits) to proximal symptomatic states (perceived stress). It isolates the degree to which worry serves as a cognitive bridge exacerbating emotional strain.
- Evaluation of Public Health Trajectories and Post-Pandemic Adaptation: The instrument uniquely incorporates items measuring the fear of returning to pre-crisis routines (the colloquially termed “cave syndrome” or re-entry syndrome), enabling public health officials to gauge community readiness for the lifting of containment measures.
Consequently, the instrument serves both epidemiological surveillance purposes and individual clinical assessments, providing a brief yet structurally complex index of pandemic-era cognitive burden.
5. Psychological Construct
The psychological construct evaluated by the instrument is pandemic-related worry, conceptualized as a chain of relatively uncontrollable, negatively valenced thoughts, images, and cognitive ruminations revolving around the acute and prolonged hazards of the COVID-19 pandemic. In psychopathology, worry represents a predominantly verbal-linguistic cognitive process aimed at anticipatory problem-solving when confronted with ambiguous, threatening environments. However, under conditions of uncontrollable, population-wide trauma, it frequently devolves into maladaptive perseveration.
The construct operationalized within this 9-item scale spans several distinct yet interconnected sub-domains of ecological threat:
- Infectious Contagion and Social Isolation: Evaluates intrusive anticipatory anxiety regarding personal contamination, viral transmission, and the prospect of mandatory medical or legal quarantine. This domain taps into the dual fear of physiological illness and involuntary structural detachment from relational support systems.
- Systemic Deprivation and Basic Resource Scarcity: Measures existential dread concerning the disruption of essential supply chains, including anxieties surrounding the scarcity of food, basic apparel, pharmaceuticals, surgical masks, and hygienic supplies required to sustain physical security.
- Macro- and Micro-Economic Instability: Assesses persistent distress over financial solvency, employment insecurity, loss of income, and the broader macro-economic collapse precipitated by national lockdowns and commercial freezes.
- Re-entry and Agoraphobic Apprehension: Captures anxiety related to leaving home confinement, reintegrating into populated environments, and resuming interpersonal transactions. This reflects a form of situational avoidance where the domestic space has been cognitively reframed as the sole safe haven.
- Disruption of Restorative Autonomy and Daily Equilibrium: Examines cognitive friction concerning the loss of personal time, hobbies, and autonomous pacing established during home-based work or confinement, capturing the apprehension associated with resuming pre-pandemic commutes and workplace stressors.
- Developmental and Future Goal Derailment: Assesses chronic worry regarding the perceived suspension or permanent destruction of educational, professional, and personal aspirations, capturing the existential demoralization stemming from prolonged societal paralysis.
Through this composition, the construct diverges from pure somatosensory health anxiety, positioning pandemic worry as an ecologically distributed, multi-systemic cognitive reaction to environmental instability.
6. Theoretical Framework
The theoretical framework informing the COVID-19-Related Worries Measure synthesizes Richard Lazarus and Susan Folkman’s Transactional Model of Stress and Coping with Thomas Borkovec’s cognitive-avoidance theory of worry, alongside contemporary dimensional models of personality pathology.
The Transactional Model of Stress and Coping
Lazarus and Folkman (1984) posited that psychological stress does not reside solely within an objective external stressor or within the individual’s baseline biological disposition. Instead, stress emerges from an active, continuous transactional relationship wherein an environmental demand is evaluated via cognitive appraisal:
- Primary Appraisal: The individual determines whether the event represents a threat, harm, or challenge. The 9 items of the COVID-19-Related Worries Measure directly operationalize this primary appraisal phase, assessing the degree to which pandemic conditions are judged as threatening to one’s physical survival, financial integrity, and social functioning.
- Secondary Appraisal: The evaluation of personal and collective resources available to mitigate the appraised threat. When perceived environmental demands vastly outstrip perceived coping resources, acute distress emerges.
Cognitive Models of Worry and Repetitive Negative Thinking
Drawing upon Borkovec’s seminal cognitive avoidance model (Borkovec et al., 1983) and Edward Watkins’s conceptualizations of repetitive negative thinking (RNT), worry is conceptualized as an internal coping attempt that paradoxically amplifies systemic physiological and emotional arousal. In an unpredictable pandemic scenario where biological pathogens cannot be visibly perceived or definitively avoided, the cognitive system generates continuous catastrophic scenarios. While initially serving an evolutionary warning function, protracted worry maintains autonomic arousal and exacerbates perceived helplessness.
Integration with Maladaptive Personality Trait Theory
The measure’s development was explicitly grounded in the Alternative Model for Personality Disorders (AMPD) introduced in DSM-5 Section III. Semeraro et al. (2023) hypothesized that baseline, trait-level vulnerabilities dictate how individuals process environmental crises:
- Negative Affectivity: A pervasive tendency to experience unpleasant emotional states, facilitating hypervigilance toward environmental threats.
- Detachment: Interpersonal withdrawal and social anhedonia, which may initially seem protective during quarantine but ultimately impedes adaptive social support-seeking.
- Psychoticism: Eccentric, unusual beliefs and cognitive dysregulation, which undermine objective evaluation of epidemiological data and foster persecutory or catastrophic interpretations of containment policies.
Within this framework, COVID-19-related worries function as a proximal cognitive mechanism: personality vulnerabilities induce heightened baseline threat sensitivity, which crystallizes into specific pandemic-related cognitive worries, ultimately overtaxing emotional regulation capacities and manifesting as elevated psychological stress.
7. Validity
The psychometric validity of the COVID-19-Related Worries Measure has been empirically supported through content, construct, convergent, and predictive validation protocols conducted within the context of structural equation modeling (SEM) frameworks (Semeraro et al., 2023).
Content and Face Validity
Content validity was established through rational item generation by clinical and educational psychologists attuned to the lived experiences of Italian adults during the pandemic. The generated items were mapped across the bio-psycho-social spectrum of the emergency, moving beyond pathogen-only transmission to include isolation, basic material scarcity, financial decline, and future goal disruption. Face validity was affirmed via preliminary pilot administration, confirming that adult respondents across varied age cohorts (young adulthood through advanced age) interpreted the items as reflections of their real-world anxieties.
Construct and Factorial Validity
The latent structure of the instrument was examined using structural modeling, confirming that the 9 items converge to represent an integrated latent dimension of pandemic-induced cognitive concern. Standardized factor loadings across items were robust, demonstrating that individual items share substantial variance with the overarching latent factor.
Convergent and Discriminant Validity
Convergent validity was verified by evaluating the measure’s statistical associations with established, standardized psychometric scales:
- Perceived Stress Scale (PSS-10): COVID-19-related worries demonstrated significant positive correlations with global subjective stress indices ($r > .40$), establishing that elevated cognitive worry directly aligns with heightened perceived strain.
- Difficulties in Emotion Regulation Scale (DERS): Scores on the measure correlated positively with emotion dysregulation dimensions, particularly non-acceptance of emotional responses, impulse control difficulties, and limited access to emotion regulation strategies.
- Personality Inventory for DSM-5 Brief Form (PID-5-BF): The measure exhibited moderate convergent associations with the Negative Affectivity domain ($r \approx .35\text{–}.45$) and smaller, distinct associations with Detachment and Psychoticism, validating theoretical predictions that neurotic dispositions amplify situational threat appraisal while remaining structurally distinct from chronic personality pathology.
Predictive and Mediational Validity
The predictive utility of the instrument was demonstrated via path analysis. In multiple mediation models, the COVID-19-Related Worries Measure accounted for unique, significant variance in psychological stress, operating as an indirect pathway linking maladaptive personality traits to psychological symptom severity. The indirect effects confirmed that without accounting for the mediating role of these specific cognitive worries, the predictive capacity of personality traits on stress outcomes remains under-specified.
8. Reliability
The reliability profile of the COVID-19-Related Worries Measure was established via classical psychometric indices of internal consistency. In the foundational validation study by Semeraro et al. (2023), administered to an adult sample ($N = 432$, encompassing individuals aged 18 to 65+ years), the 9-item scale demonstrated high internal consistency:
- Cronbach’s Alpha ($lpha$): The scale achieved an overall Cronbach’s alpha coefficient of .81. In psychometric assessment, an alpha value spanning the .80 to .89 range denotes high internal consistency, confirming that the items reliably sample the shared target construct without exhibiting excessive redundancy.
- Item-Total Correlations: Adjusted item-total correlation values across the 9 items consistently exceeded the accepted psychometric threshold of .30 (ranging from .38 to .64), confirming that each item contributes meaningfully to the common variance of the total score.
- Reliability if Item Deleted: Sequential scale reliability analyses showed that the deletion of any individual item did not significantly inflate the overall alpha coefficient beyond .81, confirming that each item is necessary to preserve construct breath.
While the initial study did not report longitudinal test-retest reliability ($r_{tt}$) due to the evolving epidemiological context, the scale’s two-week referent window was designed to detect both immediate stability and sensitivity to fluctuating epidemiological threat levels.
9. Factor Analysis
The dimensional architecture of the COVID-19-Related Worries Measure was examined within the structural modeling framework of the primary study (Semeraro et al., 2023). Structural equation modeling was utilized to evaluate the measurement model alongside structural regression pathways.
Latent Factor Structure
The scale was modeled as a unidimensional latent variable representing global pandemic-related cognitive threat appraisal, into which all 9 observed indicators loaded directly. This latent specification was tested alongside other constructs (personality traits, emotion dysregulation, and psychological stress) to confirm discriminant validity and model fit.
Model Fit Parameters
The comprehensive structural equation model incorporating the COVID-19-Related Worries Measure exhibited adequate goodness-of-fit to the empirical covariance matrix, aligning with established psychometric benchmarks:
- Comparative Fit Index (CFI): Values exceeded $.90$, indicating satisfactory fit relative to the null/independence model.
- Tucker-Lewis Index (TLI): Concordant with CFI benchmarks, supporting model parsimony.
- Root Mean Square Error of Approximation (RMSEA): Values fell below $.08$ ($90% \text{ CI } [.045, .072]$), reflecting acceptable approximation error in the population covariance matrix.
- Standardized Root Mean Square Residual (SRMR): Maintained below the $.08$ threshold, demonstrating minimal residual discrepancy between observed and predicted correlations.
Factor Loadings and Variance Extraction
All standardized factor loadings ($lambda$) for the 9 indicator items were statistically significant ($p < .001$), with loadings ranging from approximately $.45$ to $.78$. Items focusing on personal economic conditions, health quarantine, and future goal obstruction exhibited particularly strong relationships with the underlying construct, confirming their role as core markers of the pandemic stress experience.
10. Instrument / Measurement Tool
The complete technical specifications, administration protocol, and scoring instructions for the scale are outlined below:
- Test Name: COVID-19-Related Worries Measure
- Alternative Title: COVID-19 Worries Scale (Italian: Misura delle Preoccupazioni Correlate al COVID-19)
- Test Type: Psychometric Self-Report Rating Scale
- Authors: Cristina Semeraro, David Giofrè, Gabrielle Coppola, Veronica Verri, Morena Bottalico, Rosalinda Cassibba, Alessandro Taurino (2023)
- Item Count: 9 ad hoc items
- Response Continuum: 5-point Likert-type scale
- 1 = Not at all (Per nulla)
- 2 = A little (Poco)
- 3 = Moderately (Abbastanza)
- 4 = Much (Molto)
- 5 = Very much (Moltissimo)
- Temporal Referent: Experiences over the preceding two weeks (14 days)
- Target Population: General adult population (18 years and older; encompassing young adults, middle-aged individuals, and older adults)
- Administration Modality: Self-administered; accessible in paper-and-pencil, computer-assisted, or online web survey formats
- Completion Duration: Approximately 3 to 5 minutes
- Scoring Algorithm:
- No items are reverse-coded.
- Total Score Calculation: Items are summed to produce an aggregate score ranging from 9 to 45, or averaged to yield a mean index ranging from 1.0 to 5.0.
- Interpretation: Higher aggregate or mean scores reflect greater intensity and breadth of COVID-19-related cognitive worry and threat appraisal.
11. Permissions & Fee and Test Year
The COVID-19-Related Worries Measure was published in 2023 by Elsevier Ltd. in the peer-reviewed journal Personality and Individual Differences. The scale was established as an open-access empirical instrument for scientific, academic, and non-commercial educational purposes.
- Test Year: 2023
- Commercial Status: Non-commercial
- Licensing and Royalties: No fee or purchase is required to administer the instrument in non-commercial psychological or epidemiological research.
- Permissions: Researchers and clinicians are authorized to adapt and utilize the 9 items for research and teaching purposes, provided appropriate formal citation is extended to the original empirical publication (Semeraro et al., 2023). Use within commercial proprietary digital platforms requires written consent from the copyright holder and corresponding author.
- Author Contact: Cristina Semeraro, University of Bari Aldo Moro, Department of Education, Psychology, Communication, Via Scipione Crisanzio, 42, 70122 Bari, Italy. Email: [email protected].
12. References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.97780890425596
Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9–16. https://doi.org/10.1016/0005-7967(83)90121-3
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
Semeraro, C., Giofrè, D., Coppola, G., Verri, V., Bottalico, M., Cassibba, R., & Taurino, A. (2023). The role of maladaptive personality traits on psychological stress the mediating effects of COVID-19-related worries and emotional dysregulation. Personality and Individual Differences, 213, Article 112270. https://doi.org/10.1016/j.paid.2023.112270